35
This form is effective beginning with the January 1 to June 30, 2017 accounting period (2017/1) SA3E If you are filing for a prior accounting period, contact the Licensing Division for the correct form. Long Form for Secondary Transmissions by DATE RECEIVED Cable Systems (Long Form) A ACCOUNTING PERIOD COVERED BY THIS STATEMENT: Accounting 2018/1 Period Instructions: Give the full legal name of the owner of the cable system. If the owner is a subsidiary of another corporation, give the full corpo Owner rate title of the subsidiary, not that of the parent corporation List any other name or names under which the owner conducts the business of the cable system If there were different owners during the accounting period, only the owner on the last day of the accounting period should submit a single statement of account and royalty fee payment covering the entire accounting period Check here if this is the system’s first filing. If not, enter the system’s ID number assigned by the Licensing Division. 62828 LEGAL NAME OF OWNER/MAILING ADDRESS OF CABLE SYSTEM Southwestern Bell Telephone Company 2018/1 INSTRUCTIONS: In line 1, give any business or trade names used to identify the business and operation of the system unless these names already appear in space B. In line 2, give the mailing address of the system, if different from the address given in space B. System IDENTIFICATION OF CABLE SYSTEM: MAILING ADDRESS OF CABLE SYSTEM: (Number, street, rural route, apartment, or suite number) (City, town, state, zip code) D Instructions: For complete space D instructions, see page 1b. Identify only the frst community served below and relist on page 1b Area with all communities. Served CITY OR TOWN STATE First Dallas TX Below is a sample for reporting communities if you report multiple channel line-ups in Space G. CITY OR TOWN (SAMPLE) STATE Alda MD Alliance MD Gering MD Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Offce to collect the personally identifying information (PII) requested on th form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephone numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Offce's public indexes and in search reports prepared for the public. The effect of not providing the PII requested is that it may delay processing of your statement of account and its placement in the completed record of statements of account, and it may affect the legal suffciency of the fling, a determination that would be made by a court of law. AMOUNT $ For additional information, contact the U.S. Copyright Office Licensing Division at: Tel: (202) 707-8150 C Sample 62828 1010 N. St. Mary's Street, Room 13-59-B 1 2 A B B 3 Community 1 CH LINE UP 2 SUB GRP# FOR COPYRIGHT OFFICE USE ONLY San Antonio, TX 78215-2109 [email protected] STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email to: General instructions are located in the first tab of this workbook. U.S. Copyright Office Form SA3E Long Form (Rev. 0517) 8/27/2018

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Page 1: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

This form is effective beginning with the January 1 to June 30, 2017 accounting period (2017/1) SA3EIf you are filing for a prior accounting period, contact the Licensing Division for the correct form. Long Form

for Secondary Transmissions by DATE RECEIVED

Cable Systems (Long Form)

A ACCOUNTING PERIOD COVERED BY THIS STATEMENT:

Accounting 2018/1Period

Instructions: Give the full legal name of the owner of the cable system. If the owner is a subsidiary of another corporation, give the full corpo

Owner rate title of the subsidiary, not that of the parent corporationList any other name or names under which the owner conducts the business of the cable systemIf there were different owners during the accounting period, only the owner on the last day of the accounting period should submit

a single statement of account and royalty fee payment covering the entire accounting period Check here if this is the system’s first filing. If not, enter the system’s ID number assigned by the Licensing Division. 62828

LEGAL NAME OF OWNER/MAILING ADDRESS OF CABLE SYSTEM

Southwestern Bell Telephone Company

2018/1

INSTRUCTIONS: In line 1, give any business or trade names used to identify the business and operation of the system unless thesenames already appear in space B. In line 2, give the mailing address of the system, if different from the address given in space B.

System IDENTIFICATION OF CABLE SYSTEM:

MAILING ADDRESS OF CABLE SYSTEM:

(Number, street, rural route, apartment, or suite number)

(City, town, state, zip code)

D Instructions: For complete space D instructions, see page 1b. Identify only the frst community served below and relist on page 1b

Area with all communities.Served CITY OR TOWN STATE

First Dallas TX

Below is a sample for reporting communities if you report multiple channel line-ups in Space G.

CITY OR TOWN (SAMPLE) STATE

Alda MD

Alliance MD

Gering MD

Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Offce to collect the personally identifying information (PII) requested on th

form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephone

numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Offce's public indexes and in

search reports prepared for the public. The effect of not providing the PII requested is that it may delay processing of your statement of account and its placement in the

completed record of statements of account, and it may affect the legal suffciency of the fling, a determination that would be made by a court of law.

AMOUNT

 $

For additional information, contact the U.S. Copyright Office Licensing Division at: Tel: (202) 707-8150

C

Sample

62828

1010 N. St. Mary's Street, Room 13-59-B

1

2

A

B

B 3

Community

1

CH LINE UP

2

SUB GRP#

FOR COPYRIGHT OFFICE USE ONLY

San Antonio, TX 78215-2109

[email protected]

STATEMENT OF ACCOUNT

ALLOCATION NUMBER

B

6282820181

Return completed workbook by email to:

General instructions are located in the first tab of this workbook.

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

8/27/2018

Page 2: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

FORM SA3E. PAGE 1b.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company 62828

Instructions: List each separate community served by the cable system. A “community” is the same as a “community unit” as definedin FCC rules: “a separate and distinct community or municipal entity (including unincorporated communities within unincorporatedareas and including single, discrete unincorporated areas.” 47 C.F.R. §76.5(dd). The frst community that you list will serve as a form Areaof system identifcation hereafter known as the “first community.” Please use it as the first community on all future filings. Served

Note: Entities and properties such as hotels, apartments, condominiums, or mobile home parks should be reported in parenthesesbelow the identified city or town.

If all communities receive the same complement of television broadcast stations (i.e., one channel line-up for all), then either associateall communities with the channel line-up “A” in the appropriate column below or leave the column blank. If you report any stationson a partially distant or partially permitted basis in the DSE Schedule, associate each relevant community with a subscriber group,designated by a number (based on your reporting from Part 9).

When reporting the carriage of television broadcast stations on a community-by-community basis, associate each community with achannel line-up designated by an alpha-letter(s) (based on your Space G reporting) and a subscriber group designated by a number(based on your reporting from Part 9 of the DSE Schedule) in the appropriate columns below.

CITY OR TOWN STATE CH LINE UP

Dallas TX First

Addison TX Community

Aledo TXAllen TXAlvardo TXAnnetta TXAnnetta North TXAnnetta South TXArlington TXAubrey TXAurora TXAzle TXBalch Springs TXBedford TXBenbrook TXBlue Mound TXBrazos Bend TXBriaroaks TXBurleson TXCarrollton TXCedar Hill TXCelina TXCleburne TXCockrell Hill TXColleyville TXCollin Unincorporated County TXCombine TXCoppell TXCrandall TXCross Roads TXCross Timber TXCrowley TXDallas Unincorporated County TXDalworthington Gardens TXDe Soto TXDenton Unincorporated County TXDouble Oak TXDuncanville TXEdgecliff Village TXEllis Unincorporated County TXElmo TXEuless TX

D

SUB GRP#

See instructions for 

additional information 

on alphabetization.

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 3: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

Everman TXFairview TXFarmers Branch TXFate TXFlower Mound TXForest Hill TXForney TXFort Worth TXFrisco TXGarland TXGlenn Heights TXGranbury TXGrand Prairie TXGrapevine TXHackberry TXHaltom City TXHaslet TXHeath TXHighland Park TXHighland Village TXHood Unincorporated County TXHudson Oaks TXHunt Unincorporated County TXHurst TXIrving TXJohnson Unincorporated County TXJoshua TXKaufman Unincorporated County TXKeene TXKeller TXKennedale TXKrugerville TXLake Worth TXLakeside TXLakewood Village TXLancaster TXLewisville TXLittle Elm TXLowery Crossing TXLucas TXMansfield TXMcKinney TXMcLendon Chisholm TXMelissa TXMesquite TXMidlothian TXMurphy TXNew Hope TXNorth Richland Hills TXNorthlake TXOak Point TXOak Ridge TXOakleaf TXOvilla TXPantego TXParker TXParker Unincorporated County TXPecan Hill TXPlano TXProsper TX

Add rows as necessary. 

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 4: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

Providence Village TXRed Oak TXRichardson TXRichland Hills TXRiver Oaks TXRoanoke TXRockwall TXRockwall Unincorporated County TXRowlett TXRoyse City TXSachse TXSaginaw TXSansom Park TXSeagoville TXSouthlake TXSunnyvale TXTalty TXTarrant Unincorporated County TXTerrell TXThe Colony TXTrophy Club TXUniversity Park TXVenus TXWatauga TXWaxahachie TXWeatherford TXWestlake TXWestover Hills TXWestworth Village TXWhite Settlement TXWillow Park TX

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 5: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 6: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 7: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 8: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company

SECONDARY TRANSMISSION SERVICE: SUBSCRIBERS AND RATES In General: The information in space E should cover all categories of secondary transmission service of the cable system, that is, the retransmission of television and radio broadcasts by your system to subscribers. Give information

Secondary about other services (including pay cable) in space F, not here. All the facts you state must be those existing on theTransmission last day of the accounting period (June 30 or December 31, as the case may be).Service: Sub- Number of Subscribers: Both blocks in space E call for the number of subscribers to the cable system, brokenscribers and down by categories of secondary transmission service. In general, you can compute the number of subscribers in

Rates each category by counting the number of billings in that category (the number of persons or organizations charged separately for the particular service at the rate indicated—not the number of sets receiving service).

Rate: Give the standard rate charged for each category of service. Include both the amount of the charge and the unit in which it is generally billed. (Example: “$20/mth”). Summarize any standard rate variations within a particular rate category, but do not include discounts allowed for advance payment.

Block 1: In the left-hand block in space E, the form lists the categories of secondary transmission service that cable systems most commonly provide to their subscribers. Give the number of subscribers and rate for each listed category that applies to your system. Note: Where an individual or organization is receiving service that falls under different categories, that person or entity should be counted as a subscriber in each applicable category. Example: a residential subscriber who pays extra for cable service to additional sets would be included in the count under “Service to the first set” and would be counted once again under “Service to additional set(s).”

Block 2: If your cable system has rate categories for secondary transmission service that are different from those printed in block 1 (for example, tiers of services that include one or more secondary transmissions), list them, together with the number of subscribers and rates, in the right-hand block. A two- or three-word description of the service is sufficient.

NO. OFSUBSCRIBERS

Residential:

• Service to first set 19.00$ 237,616 10.00$

• Service to additional set(s) 276,573 $0-$15

• FM radio (if separate rate) 274,410 $4.99-$5.99

Motel, hotel

Commercial 20.00$

Converter

• Residential

• Non-residential

SERVICES OTHER THAN SECONDARY TRANSMISSIONS: RATES In General: Space F calls for rate (not subscriber) information with respect to all your cable system’s services that were not covered in space E, that is, those services that are not offered in combination with any secondary transmission service for a single fee. There are two exceptions: you do not need to give rate information concerning (1) services

Services furnished at cost or (2) services or facilities furnished to nonsubscribers. Rate information should include both theOther Than amount of the charge and the unit in which it is usually billed. If any rates are charged on a variable per-program basis,Secondary enter only the letters “PP” in the rate column.

Transmissions: Block 1: Give the standard rate charged by the cable system for each of the applicable services listed.Rates Block 2: List any services that your cable system furnished or offered during the accounting period that were not

listed in block 1 and for which a separate charge was made or established. List these other services in the form of a brief (two- or three-word) description and include the rate for each.

CATEGORY OF SERVICE RATE CATEGORY OF SERVICE RATE RATE Continuing Services: Installation: Non-residential

• Pay cable • Motel, hotel $0-$100

• Pay cable—add’l channel $5-$199 • Commercial $0-$35

• Fire protection • Pay cable $0-$449

•Burglar protection • Pay cable-add’l channel $99 - $149

Installation: Residential • Fire protection $10-$49

• First set $0-$199 • Burglar protection $7

• Additional set(s) Other services: $50

• FM radio (if separate rate) • Reconnect $0-$35 7.00$

• Converter • Disconnect

• Outlet relocation $0-$55

• Move to new address

F

274,410

2,163

Name

E

CATEGORY OF SERVICE RATENO. OF

SUBSCRIBERS

BLOCK 2BLOCK 1

FORM SA3E. PAGE 2.

Credit Management Fee

Dispatch on Demand

62828

CATEGORY OF SERVICE RATE

CATEGORY OF SERVICE

Wireless Receiver

Service Activation Fee

HD Tech Fee

Set-Top Box

Broadcast TV Surcharge

Video on Demand

BLOCK 1 BLOCK 2

Vacation Hold

HD Premium Tier

DVR Upgrade Fee

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 9: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

FORM SA3E. PAGE 3.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company 62828

PRIMARY TRANSMITTERS: TELEVISION

In General: In space G, identify every television station (including translator stations and low power television stations)carried by your cable system during the accounting period, except (1) stations carried only on a part-time basis underFCC rules and regulations in effect on June 24, 1981, permitting the carriage of certain network programs [sections76.59(d)(2) and (4), 76.61(e)(2) and (4), or 76.63 (referring to 76.61(e)(2) and (4))]; and (2) certain stations carried on a Primarysubstitute program basis, as explained in the next paragraph. Transmitters:

Substitute Basis Stations: With respect to any distant stations carried by your cable system on a substitute program Televisionbasis under specifc FCC rules, regulations, or authorizations:• Do not list the station here in space G—but do list it in space I (the Special Statement and Program Log)—if the

station was carried only on a substitute basis.• List the station here, and also in space I, if the station was carried both on a substitute basis and also on some other

basis. For further information concerning substitute basis stations, see page (v) of the general instructions locatedin the paper SA3 form.Column 1: List each station’s call sign. Do not report origination program services such as HBO, ESPN, etc. Identify

each multicast stream associated with a station according to its over-the-air designation. For example, report multi-cast stream as “WETA-2”. Simulcast streams must be reported in column 1 (list each stream separately; for exampleWETA-simulcast).

Column 2: Give the channel number the FCC has assigned to the television station for broadcasting over-the-air inits community of license. For example, WRC is Channel 4 in Washington, D.C. This may be different from the channelon which your cable system carried the station.

Column 3: Indicate in each case whether the station is a network station, an independent station, or a noncommercialeducational station, by entering the letter “N” (for network), “N-M” (for network multicast), “I” (for independent), “I-M”(for independent multicast), “E” (for noncommercial educational), or “E-M” (for noncommercial educational multicast).For the meaning of these terms, see page (v) of the general instructions located in the paper SA3 form.

Column 4: If the station is outside the local service area, (i.e. “distant”), enter “Yes”. If not, enter “No”. For an ex-planation of local service area, see page (v) of the general instructions located in the paper SA3 form.

Column 5: If you have entered “Yes” in column 4, you must complete column 5, stating the basis on which yourcable system carried the distant station during the accounting period. Indicate by entering “LAC” if your cable systemcarried the distant station on a part-time basis because of lack of activated channel capacity.

For the retransmission of a distant multicast stream that is not subject to a royalty payment because it is the subjectof a written agreement entered into on or before June 30, 2009, between a cable system or an association representingthe cable system and a primary transmitter or an association representing the primary transmitter, enter the designa-tion “E” (exempt). For simulcasts, also enter “E”. If you carried the channel on any other basis, enter “O.” For a furtherexplanation of these three categories, see page (v) of the general instructions located in the paper SA3 form.

Column 6: Give the location of each station. For U.S. stations, list the community to which the station is licensed by theFCC. For Mexican or Canadian stations, if any, give the name of the community with which the station is identifed.Note: If you are utilizing multiple channel line-ups, use a separate space G for each channel line-up.

CHANNEL LINE-UP AA

1. CALL 2. B’CAST 3. TYPE 4. DISTANT? 5. BASIS OF 6. LOCATION OF STATION

SIGN CHANNEL OF (Yes or No) CARRIAGE

NUMBER STATION (If Distant)

55/1055 I No

33/1033 I No

27/1027 I No

4/1004 I No

58 I No

13/1013 E No

52/1052 I No

29/1029 I No

68/1068 I No

49/1049 I No

11/1011 N No

21/1021 I No

47/1047 I No

23/1023 I No

5/1005 N No

39/1039 I No

8/1008 N No

Fort Worth, TX

Irving, TX

KTXA/KTXAHD

Name

G

See instructions for 

additional information 

on alphabetization.

Decatur, TX

Arlington, TX

Fort Worth, TX

Dallas, TX

Dallas, TX

Lake Dallas, TX

KDFI/KDFIHD

KDAF/KDAFHD

KAZD/KAZDHD

KXTX/KSTXHD Dallas, TX

Fort Worth, TX

Greenville, TX

Garland, TX

Dallas, TXWFAA/WFAAHD

KTXD/KTXDHD

KXAS/KXASHD

KUVN/KUVNHD

KPXD/KPXDHD

KSTR/KSTRHD

KTVT/KTVTHD

KMPX/KMPXHD

Fort Worth, TX

Dallas, TX

Dallas, TXKDTX

KERA/KERAHD

KFWD/KFWDHD

KDFW/KDFWHD

Dallas, TX

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 10: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

FORM SA3E. PAGE 3.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company 62828

PRIMARY TRANSMITTERS: TELEVISION

In General: In space G, identify every television station (including translator stations and low power television stations)carried by your cable system during the accounting period, except (1) stations carried only on a part-time basis underFCC rules and regulations in effect on June 24, 1981, permitting the carriage of certain network programs [sections76.59(d)(2) and (4), 76.61(e)(2) and (4), or 76.63 (referring to 76.61(e)(2) and (4))]; and (2) certain stations carried on a Primarysubstitute program basis, as explained in the next paragraph. Transmitters:

Substitute Basis Stations: With respect to any distant stations carried by your cable system on a substitute program Televisionbasis under specifc FCC rules, regulations, or authorizations:• Do not list the station here in space G—but do list it in space I (the Special Statement and Program Log)—if the

station was carried only on a substitute basis.• List the station here, and also in space I, if the station was carried both on a substitute basis and also on some other

basis. For further information concerning substitute basis stations, see page (v) of the general instructions locatedin the paper SA3 form.Column 1: List each station’s call sign. Do not report origination program services such as HBO, ESPN, etc. Identify

each multicast stream associated with a station according to its over-the-air designation. For example, report multi-cast stream as “WETA-2”. Simulcast streams must be reported in column 1 (list each stream separately; for exampleWETA-simulcast).

Column 2: Give the channel number the FCC has assigned to the television station for broadcasting over-the-air inits community of license. For example, WRC is Channel 4 in Washington, D.C. This may be different from the channelon which your cable system carried the station.

Column 3: Indicate in each case whether the station is a network station, an independent station, or a noncommercialeducational station, by entering the letter “N” (for network), “N-M” (for network multicast), “I” (for independent), “I-M”(for independent multicast), “E” (for noncommercial educational), or “E-M” (for noncommercial educational multicast).For the meaning of these terms, see page (v) of the general instructions located in the paper SA3 form.

Column 4: If the station is outside the local service area, (i.e. “distant”), enter “Yes”. If not, enter “No”. For an ex-planation of local service area, see page (v) of the general instructions located in the paper SA3 form.

Column 5: If you have entered “Yes” in column 4, you must complete column 5, stating the basis on which yourcable system carried the distant station during the accounting period. Indicate by entering “LAC” if your cable systemcarried the distant station on a part-time basis because of lack of activated channel capacity.

For the retransmission of a distant multicast stream that is not subject to a royalty payment because it is the subjectof a written agreement entered into on or before June 30, 2009, between a cable system or an association representingthe cable system and a primary transmitter or an association representing the primary transmitter, enter the designa-tion “E” (exempt). For simulcasts, also enter “E”. If you carried the channel on any other basis, enter “O.” For a furtherexplanation of these three categories, see page (v) of the general instructions located in the paper SA3 form.

Column 6: Give the location of each station. For U.S. stations, list the community to which the station is licensed by theFCC. For Mexican or Canadian stations, if any, give the name of the community with which the station is identifed.Note: If you are utilizing multiple channel line-ups, use a separate space G for each channel line-up.

CHANNEL LINE-UP AB

1. CALL 2. B’CAST 3. TYPE 4. DISTANT? 5. BASIS OF 6. LOCATION OF STATION

SIGN CHANNEL OF (Yes or No) CARRIAGE

NUMBER STATION (If Distant)

Name

G

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 11: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1 FORM SA3E. PAGE 4.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company 62828

located in the paper SA3 form.

CALL SIGN AM or FM S/D LOCATION OF STATION CALL SIGN AM or FM S/D LOCATION OF STATION

Primary Transmitters:

Radio

Special Instructions Concerning All-Band FM Carriage: Under Copyright Office regulations, an FM signal is generallyreceivable if (1) it is carried by the system whenever it is received at the system’s headend, and (2) it can be expected,on the basis of monitoring, to be received at the headend, with the system’s FM antenna, during certain stated intervals.

Name

HPRIMARY TRANSMITTERS: RADIOIn General: List every radio station carried on a separate and discrete basis and list those FM stations carried on anall-band basis whose signals were “generally receivable” by your cable system during the accounting period.

For detailed information about the the Copyright Office regulations on this point, see page (vi) of the general instructions

Column 1: Identify the call sign of each station carried. Column 2: State whether the station is AM or FM. Column 3: If the radio station’s signal was electronically processed by the cable system as a separate and discretesignal, indicate this by placing a check mark in the “S/D” column. Column 4: Give the station’s location (the community to which the station is licensed by the FCC or, in the case ofMexican or Canadian stations, if any, the community with which the station is identified).

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 12: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

FORM SA3E. PAGE 5. ACCOUNTING PERIOD:  2018/1

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company 62828

1. SPECIAL STATEMENT CONCERNING SUBSTITUTE CARRIAGE

broadcast by a distant station? X

log in block 2.2. LOG OF SUBSTITUTE PROGRAMS

FROM — TO

4. STATION'S LOCATION

In General: List each substitute program on a separate line. Use abbreviations wherever possible, if their meaning isclear. If you need more space, please attach additional pages.

the case of Mexican or Canadian stations, if any, the community with which the station is identified).

Column 1: Give the title of every nonnetwork television program (substitute program) that, during the accounting

titles, for example, “I Love Lucy” or "NBA Basketball: 76ers vs. Bulls." Column 2: If the program was broadcast live, enter “Yes.” Otherwise enter “No.” Column 3: Give the call sign of the station broadcasting the substitute program.

period, was broadcast by a distant station and that your cable system substituted for the programming of another stationunder certain FCC rules, regulations, or authorizations. See page (vi) of the general instructions located in the paper SA3 form for futher information. Do not use general categories like "movies", or "basketball". List specific program

Column 7: Enter the letter “R” if the listed program was substituted for programming that your system was required

gram was substituted for programming that your system was permitted to delete under FCC rules and regulations ineffect on October 19, 1976.

to delete under FCC rules and regulations in effect during the accounting period; enter the letter “P” if the listed pro

5. MONTH AND DAY

6. TIMES

7. REASON FOR

DELETION

SUBSTITUTE PROGRAMWHEN SUBSTITUTE

CARRIAGE OCCURRED

1. TITLE OF PROGRAM 2. LIVE? Yes or No

3. STATION'S CALL SIGN

stated as “6:00–6:30 p.m.”

Column 4: Give the broadcast station’s location (the community to which the station is licensed by the FCC or, in

Column 5: Give the month and day when your system carried the substitute program. Use numerals, with the monthfirst. Example: for May 7 give “5/7.” Column 6: State the times when the substitute program was carried by your cable system. List the times accuratelyto the nearest five minutes. Example: a program carried by a system from 6:01:15 p.m. to 6:28:30 p.m. should be

Name

ISUBSTITUTE CARRIAGE: SPECIAL STATEMENT AND PROGRAM LOG

In General: In space I, identify every nonnetwork television program broadcast by a distant station that your cable system carried on a substitute basis during the accounting period, under specific present and former FCC rules, regulations, or authorizations. For a further explanation of the programming that must be included in this log, see page (v) of the general instructions located in the paper SA3 form. Substitute

Carriage: Special

Statement and Program Log

• During the accounting period, did your cable system carry, on a substitute basis, any nonnetwork television program

YesNote: If your answer is “No”, leave the rest of this page blank. If your answer is “Yes,” you must complete the program

No

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 13: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1 FORM SA3E. PAGE 6.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company

PART-TIME CARRIAGE LOG

FROM TO FROM TO

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

• Give the month and day when the carriage occurred. Use numerals, with the month first. Example: for April 10 give

• State the starting and ending times of carriage to the nearest quarter hour. In any case where carriage ran to the end of the

DATE

HOURS

• You may group together any dates when the hours of carriage were the same. Example: “5/10-5/14, 6:00 p.m.–12:00 p.m.”

DATE

HOURS

DATES AND HOURS OF PART-TIME CARRIAGE

CALL SIGNWHEN CARRIAGE OCCURRED

CALL SIGNWHEN CARRIAGE OCCURRED

“app.” Example: “12:30 a.m.– 3:15 a.m. app.”television station’s broadcast day, you may give an approximate ending hour, followed by the abbreviation

“4/10.”

Name

Part-Time Carriage

Log

Column 1 (Call sign): Give the call sign of every distant station whose basis of carriage you identified by “LAC” incolumn 5 of space G. Column 2 (Dates and hours of carriage): For each station, list the dates and hours when part-time carriage oc-

J In General: This space ties in with column 5 of space G. If you listed a station’s basis of carriage as “LAC” for part-time carriage due to lack of activated channel capacity, you are required to complete this log giving the total dates and

curred during the accounting period.

62828

hours your system carried that station. If you need more space, please attach additional pages.

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 14: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

FORM SA3E. PAGE 7.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company

GROSS RECEIPTSInstructions: The figure you give in this space determines the form you fle and the amount you pay. Enter the total ofall amounts (gross receipts) paid to your cable system by subscribers for the system’s secondary transmission service(as identifed in space E) during the accounting period. For a further explanation of how to compute this amount, see Gross Receiptspage (vii) of the general instructions.

Gross receipts from subscribers for secondary transmission service(s)

during the accounting period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91,198,229.29$ IMPORTANT: You must complete a statement in space P concerning gross receipts. (Amount of gross receipts)

COPYRIGHT ROYALTY FEEInstructions: Use the blocks in this space L to determine the royalty fee you owe:• Complete block 1, showing your minimum fee. Copyright• Complete block 2, showing whether your system carried any distant television stations. Royalty Fee• If your system did not carry any distant television stations, leave block 3 blank. Enter the amount of the minimum

fee from block 1 on line 1 of block 4, and calculate the total royalty fee.• If your system did carry any distant television stations, you must complete the applicable parts of the DSE Schedule

accompanying this form and attach the schedule to your statement of account.

If part 8 or part 9, block A, of the DSE schedule was completed, the base rate fee should be entered on line 1 ofblock 3 below.

If part 6 of the DSE schedule was completed, the amount from line 7 of block C should be entered on line 2 in block3 below.

If part 7 or part 9, block B, of the DSE schedule was completed, the surcharge amount should be entered on line2 in block 4 below.

MINIMUM FEE: All cable systems with semiannual gross receipts of $527,600 or more are required to pay atleast the minimum fee, regardless of whether they carried any distant stations. This fee is 1.064 percent of thesystem’s gross receipts for the accounting period.

Line 1. Enter the amount of gross receipts from space K 91,198,229.29$ Line 2. Multiply the amount in line 1 by 0.01064

Enter the result here.

This is your minimum fee.

DISTANT TELEVISION STATIONS CARRIED: Your answer here must agree with the information you gave inspace G. If, in space G, you identifed any stations as “distant” by stating “Yes” in column 4, you must check“Yes” in this block.

• Did your cable system carry any distant television stations during the accounting period? Yes—Complete the DSE schedule. x No—Leave block 3 below blank and complete line 1, block 4.

Line 1. BASE RATE FEE: Enter the base rate fee from either part 8, section 3 or4, or part 9, block A of the DSE schedule. If none, enter zero

Line 2. 3.75 Fee: Enter the total fee from line 7, block C, part 6 of the DSEschedule. If none, enter zero

Line 3. Add lines 1 and 2 and enterhere

Line 1. BASE RATE FEE/3.75 FEE or MINIMUM FEE: Enter either the minimum fee

from block 1 or the sum of the base rate fee / 3.75 fee from block 3, line 3,whichever is larger Cable systems

Line 2. SYNDICATED EXCLUSIVITY SURCHARGE: Enter the fee from either part 7 submitting

(block D, section 3 or 4) or part 9 (block B) of the DSE schedule. If none, enter additional

zero. deposits under

Line 3. Line 3. INTEREST CHARGE: Enter the amount from line 4, space Q, page 9 Section 111(d)(7)

(Interest Worksheet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . should contact

the Licensing

Line 4. FILING FEE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 725.00$ additional fees.

Division for the

appropriate

TOTAL ROYALTY AND FILING FEES DUE FOR ACCOUNTING PERIOD. form for

Add Lines 1, 2 and 3 of block 4 and enter total here . . . . . . . . . . . . . . . . . . . . . . . . . . .  submitting the

additional fees.Remit this amount via electronic payment payable to Register of Copyrights. (See page (i) of thegeneral instructions located in the paper SA3 form for more information.)

Block

4

971,074.16$

0.00

0.00

Block

1

Block

L

Name

K

970,349.16$

62828

-$

2

970,349.16$

Block

3-$

0.00

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 15: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1FORM SA3E. PAGE 8.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company

CHANNELS

M Instructions: You must give (1) the number of channels on which the cable system carried television broadcast stations

to its subscribers and (2) the cable system’s total number of activated channels, during the accounting period.Channels

1. Enter the total number of channels on which the cable

system carried television broadcast stations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Enter the total number of activated channels

on which the cable system carried television broadcast stations

and nonbroadcast services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INDIVIDUAL TO BE CONTACTED IF FURTHER INFORMATION IS NEEDED: (Identify an individualwe can contact about this statement of account.)

Individual to

Be Contacted

for Further Name Telephone 210-351-4805

Address(Number, street, rural route, apartment, or suite number)

(City, town, state, zip)

Email [email protected] Fax (optional) 210-246-8199

CERTIFICATION (This statement of account must be certifed and signed in accordance with Copyright Office regulations.

OCertifcation • I, the undersigned, hereby certify that (Check one, but only one , of the boxes.)

(Owner other than corporation or partnership) I am the owner of the cable system as identifed in line 1 of space B; or

(Agent of owner other than corporation or partnership) I am the duly authorized agent of the owner of the cable system as identifiedin line 1 of space B and that the owner is not a corporation or partnership; or

X (Officer or partner) I am an officer (if a corporation) or a partner (if a partnership) of the legal entity identifed as owner of the cable systemin line 1 of space B.

• I have examined the statement of account and hereby declare under penalty of law that all statements of fact contained hereinare true, complete, and correct to the best of my knowledge, information, and belief, and are made in good faith.[18 U.S.C., Section 1001(1986)]

X

Typed or printed name:

Title: (Title of official position held in corporation or partnership)

Date:

Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Offce to collect the personally identifying information (PII) requested on thform in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephonnumbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Offce's public indexes and search reports prepared for the public. The effect of not providing the PII requested is that it may delay processing of your statement of account and its placement in thcompleted record of statements of account, and it may affect the legal suffciency of the fling, a determination that would be made by a court of law

Enter an electronic signature on the line above using an "/s/" signature to certify this statement. (e.g., /s/ John Smith). Before entering the first forward slash of the /s/ signature, place your cursor in the box and press the "F2" button, then type /s/ and your name. Pressing the "F" button will avoid enabling Excel's Lotus compatibility settings.

Mike McGuire

Assistant Vice President – Billing Operations

August 23, 2018

Information

1010 N. St. Mary's Street, Room 13-59-B

San Antonio, TX 78215

☛ /s/ Mike McGuire

Diane Bellinger

Name 62828

33

670

N

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 16: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

FORM SA3E. PAGE9.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company 62828

SPECIAL STATEMENT CONCERNING GROSS RECEIPTS EXCLUSIONSThe Satellite Home Viewer Act of 1988 amended Title 17, section 111(d)(1)(A), of the Copyright Act by adding the fol-lowing sentence:

“In determining the total number of subscribers and the gross amounts paid to the cable system for the basicservice of providing secondary transmissions of primary broadcast transmitters, the system shall not include sub-scribers and amounts collected from subscribers receiving secondary transmissions pursuant to section 119.”

For more information on when to exclude these amounts, see the note on page (vii) of the general instructions in thepaper SA3 form.

During the accounting period did the cable system exclude any amounts of gross receipts for secondary transmissionsmade by satellite carriers to satellite dish owners?

X NO

YES. Enter the total here and list the satellite carrier(s) below. . . . . . . . . . . . . . . . . $

Name Name

Mailing Address Mailing Address

INTEREST ASSESSMENTS

You must complete this worksheet for those royalty payments submitted as a result of a late payment or underpayment.

For an explanation of interest assessment, see page (viii) of the general instructions in the paper SA3 form.

Line 1 Enter the amount of late payment or underpayment . . .

x

Line 2 Multiply line 1 by the interest rate* and enter the sum here . . . . . . . . . . . . . . . . . . . .

x days

Line 3 Multiply line 2 by the number of days late and enter the sum here . . . . . . . . . . . . . .

Line 4 Multiply line 3 by 0.00274** enter here and on line 3, block 4,

space L, (page 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* To view the interest rate chart click on www.copyright.gov/licensing/interest-rate.pdf. For further assistance please

contact the Licensing Division at (202) 707-8150 or [email protected].

** This is the decimal equivalent of 1/365, which is the interest assessment for one day late.

NOTE: If you are filing this worksheet covering a statement of account already submitted to the Copyright Offce,

please list below the owner, address, first community served, accounting period, and ID number as given in the original

filing.

Owner

Address

First community served

Accounting period

ID number

Privacy Act Notice: Section 111 of title 17 of the United States Code authorizes the Copyright Offce to collect the personally identifying information (PII) requested on th

form in order to process your statement of account. PII is any personal information that can be used to identify or trace an individual, such as name, address and telephone

numbers. By providing PII, you are agreeing to the routine use of it to establish and maintain a public record, which includes appearing in the Offce's public indexes and in

search reports prepared for the public. The effect of not providing the PII requested is that it may delay processing of your statement of account and its placement in the

completed record of statements of account, and it may affect the legal suffciency of the fling, a determination that would be made by a court of law.

Name

P

Special Statement

Concerning Gross Receipts

Exclusion

Q

Interest Assessment

. . . . . . . . . . . . . . . . . .

-$

x 0.00274

(interest charge)

-

-

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 17: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1DSE SCHEDULE. PAGE 10.

The Minimum Fee⁄Base Rate Fee ⁄ 3.75 Percent Fee. All cable sys-INSTRUCTIONS FOR DSE SCHEDULE tems fling SA3E (Long Form) must pay at least the minimum fee, which is

WHAT IS A “DSE” 1.064 percent of gross receipts. The cable system pays either the minimumThe term “distant signal equivalent” (DSE) generally refers to the numerica fee or the sum of the base rate fee and the 3.75 percent fee, whichever isvalue given by the Copyright Act to each distant television station carried larger, and a Syndicated Exclusivity Surcharge, as applicable

of DSEs determines the royalty you owe. For the full definition, see page What is a “Permitted” Station? A permitted station refers to a distant(v) of the General Instructions in the paper SA3 form. station whose carriage is not subject to the 3.75 percent rate but is sub-

ject to the base rate and, where applicable, the Syndicated ExclusivityFORMULAS FOR COMPUTING A STATION’S DSE Surcharge. A permitted station would include the following:There are two different formulas for computing DSEs: (1) a basic formula 1) A station actually carried within any portion of a cable system priorfor all distant stations listed in space G (page 3), and (2) a special for- to June 25, 1981, pursuant to the former FCC rules.mula for those stations carried on a substitute basis and listed in space 2) A station first carried after June 24, 1981, which could have beenI (page 5). (Note that if a particular station is listed in both space G and carried under FCC rules in effect on June 24, 1981, if such carriagespace I, a DSE must be computed twice for that station: once under the would not have exceeded the market quota imposed for the importa-basic formula and again under the special formula. However, a station’s tion of distant stations under those rules.total DSE is not to exceed its full type-value. If this happens, contact the 3) A station of the same type substituted for a carried network, non-Licensing Division.) commercial educational, or regular independent station for which a

quota was or would have been imposed under FCC rules (47 CFR76.59 (b),(c), 76.61 (b),(c),(d), and 767.63 (a) [referring to 76.61 (b),(d)]

BASIC FORMULA: FOR ALL DISTANT STATIONS LISTED in effect on June 24, 1981.IN SPACE G OF SA3E (LONG FORM) 4) A station carried pursuant to an individual waiver granted betweenStep 1: Determine the station’s type-value. For purposes of computing April 16, 1976, and June 25, 1981, under the FCC rules and regulationsDSEs, the Copyright Act gives different values to distant stations depend- in effect on April 15, 1976.ing upon their type. If, as shown in space G of your statement of accoun 5) In the case of a station carried prior to June 25, 1981, on a part-time(page 3), a distant station is: and/or substitute basis only, that fraction of the current DSE repre-• Independent: its type-value is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 sented by prior carriage.• Network: its type-value is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.25 NOTE: If your cable system carried a station that you believe qualifies• Noncommercial educational: its type-value is . . . . . . . . . . . . . . . . . . 0.25 as a permitted station but does not fall into one of the above catego-Note that local stations are not counted at all in computing DSEs. ries, please attach written documentation to the statement of account

detailing the basis for its classifcation.

a station also depends on its basis of carriage. If, as shown in space Gof your Form SA3E, the station was carried part time because of lack ofactivated channel capacity, its basis of carriage value is determined by (1) Substitution of Grandfathered Stations. Under section 76.65 of thecalculating the number of hours the cable system carried the station during former FCC rules, a cable system was not required to delete any stationthe accounting period, and (2) dividing that number by the total number of that it was authorized to carry or was lawfully carrying prior to March 31hours the station broadcast over the air during the accounting period. The 1972, even if the total number of distant stations carried exceeded thebasis of carriage value for all other stations listed in space G is 1.0. market quota imposed for the importation of distant stations. Carriage

Step 3: Multiply the result of step 1 by the result of step 2. This gives of these grandfathered stations is not subject to the 3.75 percent rateyou the particular station’s DSE for the accounting period. (Note that for but is subject to the Base Rate, and where applicable, the Syndicatedstations other than those carried on a part-time basis due to lack of ac- Exclusivity Surcharge. The Copyright Royalty Tribunal has stated itstivated channel capacity, actual multiplication is not necessary since the view that, since section 76.65 of the former FCC rules would not haveDSE will always be the same as the type value.) permitted substitution of a grandfathered station, the 3.75 percent Rate

applies to a station substituted for a grandfathered station if carriageSPECIAL FORMULA FOR STATIONS LISTED IN of the station exceeds the market quota imposed for the importationSPACE I OF SA3E (LONG FORM) of distant stations.

Step 1: For each station, calculate the number of programs that, during theaccounting period, were broadcast live by the station and were substituted COMPUTING THE 3.75 PERCENT RATE—PART 6 OF THE DSEfor programs deleted at the option of the cable system. SCHEDULE

(These are programs for which you have entered “Yes” in column 2 and • Determine which distant stations were carried by the system pursuant“P” in column 7 of space I.) to former FCC rules in effect on June 24, 1981.

Step 2: Divide the result of step 1 by the total number of days in the • Identify any station carried prior to June 25, 198l, on a substitute and/ocalendar year (365—or 366 in a leap year). This gives you the particula part-time basis only and complete the log to determine the portion ofstation’s DSE for the accounting period. the DSE exempt from the 3.75 percent rate.

• Subtract the number of DSEs resulting from this carriage from the num-TOTAL OF DSEs ber of DSEs reported in part 5 of the DSE Schedule. This is the totalIn part 5 of this schedule you are asked to add up the DSEs for all of the number of DSEs subject to the 3.75 percent rate. Multiply these DSEsdistant television stations your cable system carried during the accounting by gross receipts by .0375. This is the 3.75 fee.period. This is the total sum of all DSEs computed by the basic formulaand by the special formula. COMPUTING THE SYNDICATED EXCLUSIVITY SURCHARGE—

PART 7 OF THE DSE SCHEDULETHE ROYALTY FEE • Determine if any portion of the cable system is located within a top 100The total royalty fee is determined by calculating the minimum fee and major television market as defined by the FCC rules and regulations inthe base rate fee. In addition, cable systems located within certain televi- effect on June 24, 1981. If no portion of the cable system is located insion market areas may be required to calculate the 3.75 fee and/or the a major television market, part 7 does not have to be completed.Syndicated Exclusivity Surcharge. Note: Distant multicast streams are not • Determine which station(s) reported in block B, part 6 are commercialsubject to the 3.75 fee or the Syndicated Exclusivity Surcharge. Distant VHF stations and place a grade B contour, in whole, or in part, over thesimulcast streams are not subject to any royalty payment cable system. If none of these stations are carried, part 7 does not have

The 3.75 Fee. If a cable system located in whole or in part within a to be completed.television market added stations after June 24, 1981, that would not have • Determine which of those stations reported in block b, part 7 of thebeen permitted under FCC rules, regulations, and authorizations (hereaf- DSE Schedule were carried before March 31,1972. These stations areter referred to as “the former FCC rules”) in effect on June 24, 1981, the exempt from the FCC’s syndicated exclusivity rules in effect on June 24system must compute the 3.75 fee using a formula based on the number 1981. If you qualify to calculate the royalty fee based upon the carriageof DSEs added. These DSEs used in computing the 3.75 fee will not be of partially-distant stations, and you elect to do so, you must computeused in computing the base rate fee and Syndicated Exclusivity Surcharge the surcharge in part 9 of this schedule.

The Syndicated Exclusivity Surcharge. Cable systems located in • Subtract the exempt DSEs from the number of DSEs determined in blockwhole or in part within a major television market, as defined by FCC rules B of part 7. This is the total number of DSEs subject to the Syndicatedand regulations, must calculate a Syndicated Exclusivity Surcharge for the Exclusivity Surcharge.carriage of any commercial VHF station that places a grade B contour, in • Compute the Syndicated Exclusivity Surcharge based upon these DSEswhole or in part, over the cable system that would have been subject to and the appropriate formula for the system’s market position.the FCC’s syndicated exclusivity rules in effect on June 24, 1981

by a cable system during an accounting period. Your system’s total number

Step 2: Calculate the station’s basis of carriage value: The DSE of

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 18: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

DSE SCHEDULE. PAGE 11.COMPUTING THE BASE RATE FEE—PART 8 OF THE DSE 5. Calculate a separate base rate fee for each subscriber group, usingSCHEDULE (1) the rates given above; (2) the total number of DSEs for that group’sDetermine whether any of the stations you carried were partially distant— complement of stations; and (3) the amount of gross receipts attributablethat is, whether you retransmitted the signal of one or more stations to to that group.subscribers located within the station’s local service area and, at the same 6. Add together the base rate fees for each subscriber group to deter-time, to other subscribers located outside that area. mine the system’s total base rate fee.• If none of the stations were partially distant, calculate your base rate 7. If any portion of the cable system is located in whole or in part within

fee according to the following rates—for the system’s permitted DSEs a major television market, you may also need to complete part 9, block Bas reported in block B, part 6 or from part 5, whichever is applicable. of the Schedule to determine the Syndicated Exclusivity Surcharge.First DSE 1.064% of gross receipts What to Do If You Need More Space on the DSE Schedule. There

Each of the second, third, and fourth DSEs 0.701% of gross receipts are no printed continuation sheets for the schedule. In most cases, theThe fifth and each additional DSE 0.330% of gross receipts blanks provided should be large enough for the necessary information. If

PARTIALLY DISTANT STATIONS—PART 9 OF THE DSE SCHEDULE you need more space in a particular part, make a photocopy of the page• If any of the stations were partially distant: in question (identifying it as a continuation sheet), enter the additional

1. Divide all of your subscribers into subscriber groups depending on information on that copy, and attach it to the DSE schedule.their location. A particular subscriber group consists of all subscribers who Rounding Off DSEs. In computing DSEs on the DSE schedule, you may

are distant with respect to exactly the same complement of stations. round off to no less than the third decimal point. If you round off a DSE in2. Identify the communities/areas represented by each subscriber group. any case, you must round off DSEs throughout the schedule as follows:3. For each subscriber group, calculate the total number of DSEs of • When the fourth decimal point is 1, 2, 3, or 4, the third decimal remains

that group’s complement of stations. unchanged (example: .34647 is rounded to .346).If your system is located wholly outside all major and smaller television • When the fourth decimal point is 5, 6, 7, 8, or 9, the third decimal is

markets, give each station’s DSEs as you gave them in parts 2, 3, and 4 rounded up (example: .34651 is rounded to .347).of the schedule; or

If any portion of your system is located in a major or smaller television The example below is intended to supplement the instructions for calculat-market, give each station’s DSE as you gave it in block B, part 6 of this ing only the base rate fee for partially distant stations. The cable systemschedule. would also be subject to the Syndicated Exclusivity Surcharge for partially

4. Determine the portion of the total gross receipts you reported in space distant stations, if any portion is located within a major television market.K (page 7) that is attributable to each subscriber group.

Distant Stations Carried Identification of Subscriber GroupsIn most cases under current FCC STATION DSE CITY OUTSIDE LOCAL GROSS RECEIPTSrules, all of Fairvale would be within A (independent) 1.0 SERVICE AREA OF FROM SUBSCRIBERSthe local service area of both stations B (independent) 1.0 Santa Rosa Stations A, B, C, D ,E $310,000.00A and C and all of Rapid City and Bo- C (part-time) 0.083 Rapid City Stations A and C 100,000.00dega Bay would be within the local D (part-time) 0.139 Bodega Bay Stations A and C 70,000.00service areas of stations B, D, and E. E (network) 0.25 Fairvale Stations B, D, and E 120,000.00

TOTAL DSEs 2.472 TOTAL GROSS RECEIPTS $600,000.00

Minimum Fee Total Gross Receiptsx  .01064

First Subscriber Group Second Subscriber Group Third Subscriber Group(Santa Rosa) (Rapid City and Bodega Bay) (Fairvale)

Gross receipts $310,000.00 Gross receipts $170,000.00 Gross receipts $120,000.00DSEs 2.472 DSEs 1.083 DSEs 1.389Base rate fee $6,497.20 Base rate fee $1,907.71 Base rate fee $1,604.03$310,000 x .01064 x 1.0 = 3,298.40 $170,000 x .01064 x 1.0 = 1,808.80 $120,000 x .01064 x 1.0 = 1,276.80$310,000 x .00701 x 1.472 = 3,198.80 $170,000 x .00701 x .083 = 98.91 $120,000 x .00701 x .389 = 327.23Base rate fee $6,497.20 Base rate fee $1,907.71 Base rate fee $1,604.03

Total Base Rate Fee: $6,497.20 + $1,907.71 + $1,604.03 = $10,008.94 In this example, the cable system would enter $10,008.94 in space L, block 3, line 1 (page 7)

EXAMPLE:

$6,384.00

COMPUTATION OF COPYRIGHT ROYALTY FEE FOR CABLE SYSTEM CARRYING PARTIALLY DISTANT STATIONS

$600,000.00Santa Rosa

Fairvale

Rapid City

BodegaBay

Stations A and C 35 mile zone

Stations B, D,and E 

35 mile zone

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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ACCOUNTING PERIOD:  2018/1

DSE SCHEDULE. PAGE 11. (CONTINUED)

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company

SUM OF DSEs OF CATEGORY “O” STATIONS:• Add the DSEs of each station.Enter the sum here and in line 1 of part 5 of this schedule.

Instructions:In the column headed “Call Sign”: list the call signs of all distant stations identified by the letter “O” in column 5of space G (page 3).In the column headed “DSE”: for each independent station, give the DSE as “1.0”; for each network or noncom-mercial educational station, give the DSE as “.25.”

CATEGORY “O” STATIONS: DSEs

DSE DSE

Add rows as 

necessary. 

Remember to copy 

all formula into new 

rows.

2Computation

1

CALL SIGN

of DSEs for

Category “O”

Stations DSE

62828

CALL SIGN

0.00

CALL SIGN

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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ACCOUNTING PERIOD:  2018/1DSE SCHEDULE. PAGE 12.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company

Instructions: CAPACITY Column 1: List the call sign of all distant stations identified by “LAC” in column 5 of space G (page 3). Column 2: For each station, give the number of hours your cable system carried the station during the accounting period. This figure should correspond with the information given in space J. Calculate only one DSE for each station.

Computation Column 3: For each station, give the total number of hours that the station broadcast over the air during the accounting period.

of DSEs for Column 4: Divide the figure in column 2 by the figure in column 3, and give the result in decimals in column 4. This figure must

Stations be carried out at least to the third decimal point. This is the “basis of carriage value” for the station.

Carried Part Column 5: For each independent station, give the “type-value” as “1.0.” For each network or noncommercial educational station,

Time Due to give the type-value as “.25.”

Lack of Column 6: Multiply the figure in column 4 by the figure in column 5, and give the result in column 6. Round to no less than the

Activated third decimal point. This is the station’s DSE. (For more information on rounding, see page (viii) of the general instructions in the paper

Channel SA3 form.

Capacity

÷ = x =

÷ = x =

÷ = x =

÷ = x =

÷ = x =

÷ = x =

÷ = x =

÷ = x =

SUM OF DSEs OF CATEGORY LAC STATIONS:Add the DSEs of each station. Enter the sum here and in line 2 of part 5 of this schedule, . . . . . . . . . . . . . . . . . . . . .

Instructions:Column 1: Give the call sign of each station listed in space I (page 5, the Log of Substitute Programs) if that station: • Was carried by your system in substitution for a program that your system was permitted to delete under FCC rules and regular- tions in effect on October 19, 1976 (as shown by the letter “P” in column 7 of space I); and

Computation • Broadcast one or more live, nonnetwork  programs during  that optional  carriage  (as shown by the word “Yes” in column 2 ofof DSEs for space I).Substitute- Column 2: For each station give the number of live, nonnetwork programs carried in substitution for programs that were deleted

Basis Stations at your option. This figure should correspond with the information in space I. Column 3: Enter the number of days in the calendar year: 365, except in a leap year. Column 4: Divide the figure in column 2 by the figure in column 3, and give the result in column 4. Round to no less than the thirddecimal point. This is the station’s DSE (For more information on rounding, see page (viii) of the general instructions in the paper SA3 form).

4. DSE 1. CALL 4. DSE SIGN

÷ = ÷ =

÷ = ÷ =

÷ = ÷ =

÷ = ÷ =

÷ = ÷ =

÷ = ÷ =

SUM OF DSEs OF SUBSTITUTE-BASIS STATIONS:Add the DSEs of each station. Enter the sum here and in line 3 of part 5 of this schedule, . . . . . . . . . . . . . . . . . .

TOTAL NUMBER OF DSEs: Give the amounts from the boxes in parts 2, 3, and 4 of this schedule and add them to provide the tota

number of DSEs applicable to your system.

Total Number 1. Number of DSEs from part 2

of DSEs 2. Number of DSEs from part 3

3. Number of DSEs from part 4

TOTAL NUMBER OF DSEs

____________________________________ 0.00

0.00

0.00

___________________________________

___________________________________ 0.00

0.00

5

OF DAYS IN YEAR

0.00

4

3. NUMBER 2. NUMBER

SUBSTITUTE-BASIS STATIONS: COMPUTATION OF DSEs

1. CALL 2. NUMBER 3. NUMBER SIGN

PROGRAMS IN YEAR PROGRAMS OF OF DAYS OF

SYSTEM

SIGN OF HOURS OF HOURS CARRIAGE

ON AIR

5. TYPE 6. DSE

Name

3

CATEGORY LAC STATIONS: COMPUTATION OF DSEs

1. CALL 2. NUMBER 3. NUMBER

62828

4. BASIS OF VALUE

STATION VALUE CARRIED BY

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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DSE SCHEDULE. PAGE 13. ACCOUNTING PERIOD:  2018/1

SYSTEM ID#Southwestern Bell Telephone Company

6

Yes—Complete part 8 of the schedule—DO NOT COMPLETE THE REMAINDER OF PART 6 AND 7

X

Column 2: Enter the appropriate letter indicating the basis on which you carried a permitted stationBASIS OF (Note the FCC rules and regulations cited below pertain to those in effect on June 24, 1981.PERMITTED A Stations carried pursuant to the FCC market quota rules [76.57, 76.59(b), 76.61(b)(c), 76.63(a) referring toCARRIAGE 76.61(b)(c)]

B Specialty station as defined in 76.5(kk) (76.59(d)(1), 76.61(e)(1), 76.63(a) referring to 76.61(e)(1C Noncommerical educational station [76.59(c), 76.61(d), 76.63(a) referring to 76.61(d)D Grandfathered station (76.65) (see paragraph regarding substitution of grandfathered stations in the instructions for DSE schedule).E Carried pursuant to individual waiver of FCC rules (76.7)*F A station previously carried on a part-time or substitute basis prior to June 25, 1981G Commercial UHF station within grade-B contour, [76.59(d)(5), 76.61(e)(5), 76.63(a) referring to 76.61(e)(5)M Retransmission of a distant multicast stream.

Column 3:

2. PERMITTED 3. DSE 1. CALL 2. PERMITTED 3. DSE 1. CALL 2. PERMITTED 3. DSEBASIS SIGN BASIS SIGN BASIS

Line 1: Enter the total number of DSEs from part 5 of this schedule

Line 2: Enter the sum of permitted DSEs from block B above

Line 4: Enter gross receipts from space K (page 7)

Line 5: Multiply line 4 by 0.0375 and enter sum here

Line 7: Multiply line 6 by line 5 and enter here and on line 2, block 3, space L (page 7) 0.00

- Line 6: Enter total number of DSEs from line 3

NameLEGAL NAME OF OWNER OF CABLE SYSTEM:

Computation of3.75 Fee

BLOCK B: CARRIAGE OF PERMITTED DSEs

Is the cable system located wholly outside of all major and smaller markets as defined under section 76.5 of FCC rules and regulations in effect on June 24, 1981?

No—Complete blocks B and C below.

62828

BLOCK A: TELEVISION MARKETS

Do any of theDSEs represent

partiallypermited/partially

nonpermittedcarriage?

If yes, see part9 instructions.

x 0.0375

SIGN

-

0.00

BLOCK C: COMPUTATION OF 3.75 FEE

(If zero, leave lines 4–7 blank and proceed to part 7 of this schedule) 0.00

x

Line 3: Subtract line 2 from line 1. This is the total number of DSEs subject to the 3.75 rate.

-

List the DSE for each distant station listed in parts 2, 3, and 4 of the schedule.*(Note: For those stations identified by the letter “F” in column 2, you must complete the worksheet on page 14 ofthis schedule to determine the DSE.)

1. CALL

Instructions: Block A must be completed.In block A:• If your answer if “Yes,” leave the remainder of part 6 and part 7 of the DSE schedule blank and complete part 8, (page 16) of theschedule.• If your answer if “No,” complete blocks B and C below.

Column 1:CALL SIGN

List the call signs of distant stations listed in part 2, 3, and 4 of this schedule that your system was permitted to carry under FCC rules and regulations prior to June 25, 1981. For further explanation of permitted stations, see theinstructions for the DSE Schedule. (Note: The letter M below refers to an exempt multicast stream as set forth in the Satellite Television Extension and Localism Act of 2010.)

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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DSE SCHEDULE. PAGE 13. (CONTINUED) ACCOUNTING PERIOD:  2018/1

SYSTEM ID#Southwestern Bell Telephone Company

2. PERMITTED 3. DSE 1. CALL 2. PERMITTED 3. DSE 1. CALL 2. PERMITTED 3. DSEBASIS SIGN BASIS SIGN BASIS

Name

BLOCK A: TELEVISION MARKETS (CONTINUED)

Computation of3.75 Fee

6

62828LEGAL NAME OF OWNER OF CABLE SYSTEM:

1. CALL SIGN

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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ACCOUNTING PERIOD:  2018/1

DSE SCHEDULE. PAGE 14.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID##Southwestern Bell Telephone Company

Worksheet forComputating

the DSESchedule for

PermittedPart-Time and

SubstituteCarriage

Computation

of the

Syndicated

Exclusivity

Surcharge

X Yes—Complete blocks B and C . No—Proceed to part 8

Yes—List each station below with its appropriate permitted DSE Yes—List each station below with its appropriate permitted DSE

X No—Enter zero and proceed to part 8. X No—Enter zero and proceed to part 8.

DSE DSE DSE DSE

0.00 0.00

(Note that the FCC rules and regulations cited below pertain to those in effect on June 24, 1981. A—Part-time specialty programming: Carriage, on a part-time basis, of specialty programming under FCC rules, sections

76.59(d)(1),76.61(e)(1), or 76.63 (referring to 76.61(e)(1)).

Instructions: You must complete this worksheet for those stations identifed by the letter “F” in column 2 of block B, part 6 (i.e., thosestations carried prior to June 25, 1981, under former FCC rules governing part-time and substitute carriage.Column 1: List the call sign for each distant station identifed by the letter “F” in column 2 of part 6 of the DSE scheduleColumn 2: Indicate the DSE for this station for a single accounting period, occurring between January 1, 1978 and June 30, 1981Column 3: Indicate the accounting period and year in which the carriage and DSE occurred (e.g., 1981/1)

Name62828

Column 4: Indicate the basis of carriage on which the station was carried by listing one of the following letters

Column 5: Indicate the station’s DSE for the current accounting period as computed in parts 2, 3, and 4 of this scheduleColumn 6: Compare the DSE figures listed in columns 2 and 5 and list the smaller of the two figures here. This figure should be entered

4. BASIS OF 6. PERMITTED

PERMITTED DSE FOR STATIONS CARRIED ON A PART-TIME AND SUBSTITUTE BASIS

B—Late-night programming: Carriage under FCC rules, sections 76.59(d)(3), 76.61(e)(3), or 76.63 (referring to

DSE

general instructions in the paper SA3 form.

statement of account on fle in the Licensing Division.

in block B, column 3 of part 6 for this station.

3. ACCOUNTING

76.61(e)(3)).

IMPORTANT: The information you give in columns 2, 3, and 4 must be accurate and is subject to verifcation from the designated

S—Substitute carriage under certain FCC rules, regulations, or authorizations. For further explanation, see page (vi) of the

7 If your answer is “Yes,” complete blocks B and C, below.

BLOCK A: MAJOR TELEVISION MARKET

Is any station listed in block B of part 6 the primary stream of anity served by the cable system prior to March 31, 1972? (refe

1. CALL 5. PRESENT

DSEDSE

2. PRIOR

SIGN CARRIAGEPERIOD

Instructions: Block A must be completed.

If your answer is “No,” leave blocks B and C blank and complete part 8 of the DSE schedule.

BLOCK B: Carriage of VHF/Grade B Contour Stations BLOCK C: Computation of Exempt DSEs

Was any station listed in block B of part 7 carried in any commu-

CALL SIGNCALL SIGN

to former FCC rule 76.159)

In block A:

commercial VHF station that places a grade B contour, in whole

• Is any portion of the cable system within a top 100 major television market as defned by section 76.5 of FCC rules in effect June 24, 1981?

CALL SIGN CALL SIGN

TOTAL DSEs

or in part, over the cable system?

TOTAL DSEs

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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ACCOUNTING PERIOD:  2018/1

DSE SCHEDULE. PAGE15.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company

Enter the amount of gross receipts from space K (page 7) . . . . $ 7

A. Enter the total DSEs from block B of part 7 . . . . . . . . . . . . . .

B. Enter the total number of exempt DSEs from block C of part 7 . . . . . . . . . . . . . . . . . . .

C. Subtract line B from line A and enter here. This is the total number of DSEs

subject to the surcharge computation. If zero, proceed to part 8. . . . . . . . . . . . . . . . $

• Is any portion of the cable system within a top 50 television market as defned by the FCC?

Yes—Complete section 3 below. X No—Complete section 4 below.

• Did your cable system retransmit the signals of any partially distant television stations during the accounting period?

  Yes—Complete part 9 of this schedule. X No—Complete the applicable section below.

If the figure in section 2, line C is 4.000 or less, compute your surcharge here and leave section 3b blank. NOTE: If the DSEis 1.0 or less, multiply the gross receipts by .00599 by the DSE. Enter the result on line A below.

A. Enter 0.00599 of gross receipts (the amount in section1) . . . . $

B. Enter 0.00377 of gross receipts (the amount in section 1) . . . . . . . . . . . . . . . . . . . . . . . . $

C. Subtract 1.000 from total permitted DSEs (the figure on

line C in section 2) and enter here . . . . . . . .

D. Multiply line B by line C and enter here . . . .

E. Add lines A and D. This is your surcharge. Enter here and on line 2 of block 4 in space L (page 7)  Syndicated Exclusivity Surcharge . . . . . . . $

If the figure in section 2, line C is more than 4.000, compute your surcharge here and leave section 3a blank.

A. Enter 0.00599 of gross receipts (the amount in section 1) . . . $

B. Enter 0.00377 of gross receipts (the amount in section 1) . . . . . . . . . . . . . . . . . . . . . . $

C. Multiply line B by 3.000 and enter here . . . . $

D. Enter 0.00178 of gross receipts (the amount in section 1) . . . . . . . . . . . . . . . . . . . . . . $

E. Subtract 4.000 from total DSEs (the fgure on line C in section 2) and enter here

F. Multiply line D by line E and enter here . . . . $

G. Add lines A, C, and F. This is your surcharge. Enter here and on line 2 of block 4 in space L (page 7)  Syndicated Exclusivity Surcharge . . . . . . . $

Did your cable system retransmit the signals of any partially distant television stations during the accounting period?

  Yes—Complete part 9 of this schedule. X No—Complete the applicable section below.

If the figure in section 2, line C is 4.000 or less, compute your surcharge here and leave section 4b blank. NOTE: If the DSEis 1.0 or less, multiply the gross receipts by 0.003 by the DSE. Enter the result on line A below.A. Enter 0.00300 of gross receipts (the amount in section 1) . . . $

B. Enter 0.00189 of gross receipts (the amount in section 1) . . . . . . . . . . . . . . . . . . . . . . . $

C.Subtract 1.000 from total permitted DSEs (the fgure on line C in section 2) and enter here . . . . . . . . . .

D. Multiply line B by line C and enter here . . . . $

E. Add lines A and D. This is your surcharge. Enter here and on line 2 of block 4 in space L (page 7)  Syndicated Exclusivity Surcharge . . . . . . . $

Name

BLOCK D: COMPUTATION OF THE SYNDICATED EXCLUSIVITY SURCHARGE

Section1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91,198,229.29

62828

Computationof the

SyndicatedExclusivitySurcharge

. . . . . . . . . . . . . . . . . . .

0.00

0.00

SECTION 3: TOP 50 TELEVISION MARKET

Section2

0.00. . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section3a

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section3b

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SECTION 4: SECOND 50 TELEVISION MARKET

Section4a

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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ACCOUNTING PERIOD:  2018/1

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company

If the figure in section 2, line C is more than 4.000, compute your surcharge here and leave section 4a blank.

Computation A. Enter 0.00300 of gross receipts (the amount in section 1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . $of the

Syndicated B. Enter 0.00189 of gross receipts (the amount in section 1). . . . . . . . . . . . . . . . . . . . . . . . . . $ExclusivitySurcharge C. Multiply line B by 3.000 and enter here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

D. Enter 0.00089 of gross receipts (the amount in section 1). . . . . . . . . . . . . . . . . . . . . . . . . . $

E. Subtract 4.000 from the total DSEs (the figure on line C in

section 2) and enter here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .

F. Multiply line D by line E and enter here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

G. Add lines A, C, and F. This is your surcharge. Enter here and on line 2, block 4, space L (page 7)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Instructions:

You must complete this part of the DSE schedule for the SUM OF PERMITTED DSEs in part 6, block B; however, if block A of part

6 was checked “Yes,” use the total number of DSEs from part 5.

• In block A, indicate, by checking “Yes” or “No,” whether your system carried any partially distant stations.

Computation • If your answer is “No,” compute your system’s base rate fee in block B. Leave part 9 blank.

of • If your answer is “Yes” (that is, if you carried one or more partially distant stations), you must complete part 9. Leave block B below

Base Rate Fee blank.

What is a partially distant station? A station is “partially distant” if, at the time your system carried it, some of your subscribers

were located within that station’s local service area and others were located outside that area. For the definition of a station’s “local

service area,” see page (v) of the general instructions.

• Did your cable system retransmit the signals of any partially distant television stations during the accounting period?

Yes—Complete part 9 of this schedule. X No—Complete the following sections.

Enter the amount of gross receipts from space K (page 7). . . . . . . . . . . . . . . . . . . . . . . . . $

Enter the total number of permitted DSEs from block B, part 6 of this schedule.

(If block A of part 6 was checked “Yes,”

use the total number of DSEs from part 5.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the figure in section 2 is 4.000 or less, compute your base rate fee here and leave section 4 blank.

NOTE: If the DSE is 1.0 or less, multiply the gross receipts by 0.01064 by the DSE. Enter the result on line A below.

A. Enter 0.01064 of gross receipts

(the amount in section 1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

B. Enter 0.00701 of gross receipts

(the amount in section 1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Subtract 1.000 from total DSEs

(the figure in section 2) and enter here. . . . . . . . . . . . . . . . .

D. Multiply line B by line C and enter here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

E. Add lines A, and D. This is your base rate fee. Enter here

and in block 3, line 1, space L (page 7)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

-

DSE SCHEDULE. PAGE 16.

62828

BLOCK A: CARRIAGE OF PARTIALLY DISTANT STATIONS

Syndicated Exclusivity Surcharge. . . . . . . . . . . . . . . . . . . . . . .

- Base Rate Fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$.

-

BLOCK B: NO PARTIALLY DISTANT STATIONS—COMPUTATION OF BASE RATE FEE

$.

639,299.59$

-

3

Section

91,198,229.29

Section

2

1

Section

0.00

8

Name

7 Section

4b

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

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DSE SCHEDULE. PAGE 17. ACCOUNTING PERIOD:  2018/1

SYSTEM ID#

Southwestern Bell Telephone Company

If the figure in section 2 is more than 4.000, compute your base rate fee here and leave section 3 blank.

A. Enter 0.01064 of gross receipts

(the amount in section 1) $

B. Enter 0.00701 of gross receipts

(the amount in section 1) $

C. Multiply line B by 3.000 and enter here $

D. Enter 0.00330 of gross receipts

(the amount in section 1) $

E. Subtract 4.000 from total DSEs

(the figure in section 2) and enter here

F. Multiply line D by line E and enter here $

G. Add lines A, C, and F. This is your base rate fee.Enter here and in block 3, line 1, space L (page 7)Base Rate Fee $

• Add the DSEs for each station. This gives you the total DSEs for the particular subscriber group.

• Calculate gross receipts for the subscriber group. For further explanation of gross receipts see page (vii) of the general instructions in the paper SA3 form.

LEGAL NAME OF OWNER OF CABLE SYSTEM:

Computation of

Base Rate Fee

8

Name62828

0.00

9Computation

ofBase Rate Fee

andSyndicatedExclusivitySurcharge

forPartiallyDistant

Stations, andfor PartiallyPermittedStations

IMPORTANT: It is no longer necessary to report television signals on a system-wide basis. Carriage of television broadcast signals shall instead be reported on a community-by-community basis (subscriber groups) if the cable system reported multiple channel line-ups in Space G.

In General: If any of the stations you carried were partially distant, the statute allows you, in computing your base rate fee, to exclude receipts from subscribers located within the station’s local service area, from your system’s total gross receipts. To take advantage of this exclusion, you must:

How to Identify a Subscriber Group for Partially Distant Stations

First: Divide all of your subscribers into subscriber groups, each group consisting entirely of subscribers that are distant to the same station or the same group of stations. Next: Treat each subscriber group as if it were a separate cable system. Determine the number of DSEs and the portion of your system’s gross receipts attributable to that group, and calculate a separate base rate fee for each group.

Finally: Add up the separate base rate fees for each subscriber group. That total is the base rate fee for your system.

NOTE: If any portion of your cable system is located within the top 100 television market and the station is not exempt in part 7, you must also compute a Syndicated Exclusivity Surcharge for each subscriber group. In this case, complete both block A and B below. However, if your cable system is wholly located outside all major television markets, complete block A only.

Step 1: For each community served, determine the local service area of each wholly distant and each partially distant station youcarried to that community.

Step 2: For each wholly distant and each partially distant station you carried, determine which of your subscribers were locatedoutside the station’s local service area. A subscriber located outside the local service area of a station is distant to that station (and, by the same token, the station is distant to the subscriber.)

Step 3: Divide your subscribers into subscriber groups according to the complement of stations to which they are distant. Eachsubscriber group must consist entirely of subscribers who are distant to exactly the same complement of stations. Note that a cable system will have only one subscriber group when the distant stations it carried have local service areas that coincide.

Section

4

• Compute a base rate fee for each subscriber group using the formula outline in block B of part 8 of this schedule on the preceding page. In making this computation, use the DSE and gross receipts figure applicable to the particular subscriber group (that is, the total DSEs for that group's complement of stations and total gross receipts from the subscribers in that group). You do not need to show your actual calculations on the form.

Computing the base rate fee for each subscriber group: Block A contains separate sections, one for each of your system’s subscriber groups.

In each section:

• Identify the communities/areas represented by each subscriber group.

• Give the call sign for each of the stations in the subscriber group’s complement—that is, each station that is distant to all of thesubscribers in the group.

• If:

1) your system is located wholly outside all major and smaller television markets, give each station’s DSE as you gave it in parts 2, 3, and 4 of this schedule; or,

2) any portion of your system is located in a major or smaller televison market, give each station’s DSE as you gave it in block B, part 6 of this schedule.

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 27: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

DSE SCHEDULE. PAGE 18.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#

Southwestern Bell Telephone Company 62828Guidance for Computing the Royalty Fee for Partially Permitted/Partially NonPermitted Signals

Step 1: Use part 9, block A, of the DSE Schedule to establish subscriber groups to compute the base rate fee for wholly and

partially permitted distant signals. Write “Permitted Signals” at the top of the page. Note: One or more permitted signals in these

subscriber groups may be partially distant.

Step 2: Use a separate part 9, block A, to compute the 3.75 percent fee for wholly nonpermitted and partially nonpermitted distant

signals. Write “Nonpermitted 3.75 stations” at the top of this page. Multiply the subscriber group gross receipts by total DSEs by

.0375 and enter the grand total 3.75 percent fees on line 2, block 3, of space L. Important: The sum of the gross receipts reported

for each part 9 used in steps 1 and 2 must equal the amount reported in space K.

Step 3: Use part 9, block B, to compute a syndicated exclusivity surcharge for any wholly or partially permitted distant

signals from step 1 that is subject to this surcharge.

Guidance for Computing the Royalty Fee for Carriage of Distant and Partially Distant Multicast Streams

Step 1: Use part 9, Block A, of the DSE Schedule to report each distant multicast stream of programming that is transmitted from

a primary television broadcast signal. Only the base rate fee should be computed for each multicast stream. The 3.75 Percent Rate

and Syndicated Exclusivity Surcharge are not applicable to the secondary transmission of a multicast stream.

You must report but not assign a DSE value for the retransmission of a multicast stream that is the subject of a written agreement

entered into on or before June 30, 2009 between a cable system or an association representing the cable system and a primary

transmitter or an association representing the primary transmitter.

Name

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 28: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1FORM SA3E. PAGE 19.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company

FIRST SUBSCRIBER GROUP SECOND SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

Computation

CALL SIGN DSE CALL SIGN DSE of

Base Rate Fee

and

Syndicated

Exclusivity

Surcharge

for

Partially

Distant

Stations

Total DSEs Total DSEs

Gross Receipts First Group $ Gross Receipts Second Group $

Base Rate Fee First Group $ Base Rate Fee Second Group $

THIRD SUBSCRIBER GROUP FOURTH SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

CALL SIGN DSE CALL SIGN DSE

Total DSEs Total DSEs

Gross Receipts Third Group $ Gross Receipts Fourth Group $

Base Rate Fee Third Group $ Base Rate Fee Fourth Group $

Base Rate Fee: Add the base rate fees for each subscriber group as shown in the boxes above.Enter here and in block 3, line 1, space L (page 7) $

0

0.00

0

Name

BLOCK A: COMPUTATION OF BASE RATE FEES FOR EACH SUBSCRIBER GROUP

CALL SIGN

0

DSE

9

62828

DSE CALL SIGN

CALL SIGN

0.00

0.00

0.00

0.00

DSE

91,198,229.29

DSE

0.00

0.00

0.00

0.000.00

CALL SIGN

0

0.00

0.00

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 29: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1FORM SA3E. PAGE 19.

LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company 62828

FIFTH SUBSCRIBER GROUP SIXTH SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

Computation

CALL SIGN DSE CALL SIGN DSE of

Base Rate Fee

and

Syndicated

Exclusivity

Surcharge

for

Partially

Distant

Stations

Total DSEs Total DSEs

Gross Receipts First Group $ Gross Receipts Second Group $

Base Rate Fee First Group $ Base Rate Fee Second Group $

SEVENTH SUBSCRIBER GROUP EIGHTH SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

CALL SIGN DSE CALL SIGN DSE

Total DSEs Total DSEs

Gross Receipts Third Group $ Gross Receipts Fourth Group $

Base Rate Fee Third Group $ Base Rate Fee Fourth Group $

Base Rate Fee: Add the base rate fees for each subscriber group as shown in the boxes above.Enter here and in block 3, line 1, space L (page 7) $

DSE CALL SIGN DSE

Name

BLOCK A: COMPUTATION OF BASE RATE FEES FOR EACH SUBSCRIBER GROUP

90 0

0.000.00

CALL SIGN

0.00

CALL SIGN DSE

0.00

0.00 0.00

0 0

CALL SIGN DSE

0.00

0.00 0.00

0.00

0.00

0.00

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 30: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1FORM SA3E. PAGE 19. Nonpermitted 3.75 StationsLEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company 62828

FIRST SUBSCRIBER GROUP SECOND SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

Computation

CALL SIGN DSE CALL SIGN DSE of

Base Rate Fee

and

Syndicated

Exclusivity

Surcharge

for

Partially

Distant

Stations

Total DSEs Total DSEs

Gross Receipts First Group $ Gross Receipts Second Group $

Base Rate Fee First Group $ Base Rate Fee Second Group $

THIRD SUBSCRIBER GROUP FOURTH SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

CALL SIGN DSE CALL SIGN DSE

Total DSEs Total DSEs

Gross Receipts Third Group $ Gross Receipts Fourth Group $

Base Rate Fee Third Group $ Base Rate Fee Fourth Group $

Base Rate Fee: Add the base rate fees for each subscriber group as shown in the boxes above.Enter here and in block 3, line 1, space L (page 7) $

0.00

0.00

0.00 0.00

0.00

0.00 0.00

CALL SIGN

DSE CALL SIGN

0

0

DSE

91,198,229.29 0.00

0.00 0.00

0.00 0.00

Name

BLOCK A: COMPUTATION OF BASE RATE FEES FOR EACH SUBSCRIBER GROUP

90 0

DSE CALL SIGN DSE CALL SIGN

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 31: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1FORM SA3E. PAGE 19. Nonpermitted 3.75 StationsLEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company 62828

FIFTH SUBSCRIBER GROUP SIXTH SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

Computation

CALL SIGN DSE CALL SIGN DSE of

Base Rate Fee

and

Syndicated

Exclusivity

Surcharge

for

Partially

Distant

Stations

Total DSEs Total DSEs

Gross Receipts First Group $ Gross Receipts Second Group $

Base Rate Fee First Group $ Base Rate Fee Second Group $

SEVENTH SUBSCRIBER GROUP EIGHTH SUBSCRIBER GROUP

COMMUNITY/ AREA COMMUNITY/ AREA

CALL SIGN DSE CALL SIGN DSE

Total DSEs Total DSEs

Gross Receipts Third Group $ Gross Receipts Fourth Group $

Base Rate Fee Third Group $ Base Rate Fee Fourth Group $

Base Rate Fee: Add the base rate fees for each subscriber group as shown in the boxes above.Enter here and in block 3, line 1, space L (page 7) $

0.00

0.00

0.00

0.00 0.00

0.00

0.00 0.00

CALL SIGN DSE

00

0.00

0.00 0.00

0.00

CALL SIGN DSE

CALL SIGN

Name

BLOCK A: COMPUTATION OF BASE RATE FEES FOR EACH SUBSCRIBER GROUP

90 0

DSE CALL SIGN DSE

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 32: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

FORM SA3E. PAGE 20.LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company 62828

If your cable system is located within a top 100 television market and the station is not exempt in Part 7, you must also compute a

Syndicated Exclusivity Surcharge. Indicate which major television market any portion of your cable system is located in as definedby section 76.5 of FCC rules in effect on June 24, 1981:

Computationof First 50 major television market Second 50 major television market

Base Rate Fee INSTRUCTIONS:and Step 1: In line 1, give the total DSEs by subscriber group for commercial VHF Grade B contour stations listed in block A, part 9 of

Syndicated this schedule.Exclusivity Step 2:  In line 2, give the total number of DSEs by subscriber group for the VHF Grade B contour stations that were classified as

Surcharge Exempt DSEs in block C, part 7 of this schedule. If none enter zero.for Step 3:  In line 3, subtract line 2 from line 1. This is the total number of DSEs used to compute the surcharge.

Partially Step 4:  Compute the surcharge for each subscriber group using the formula outlined in block D, section 3 or 4 of part 7 of this

Distant schedule. In making this computation, use gross receipts figures applicable to the particular group. You do not need to showStations your actual calculations on this form.

Line 1: Enter the VHF DSEs . . . . . . . Line 1: Enter the VHF DSEs . . . . . .

Line 2: Enter the Exempt DSEs . . . . . Line 2: Enter the Exempt DSEs . . . . .

Line 3: Subtract line 2 from line 1 Line 3: Subtract line 2 from line 1 and enter here. This is the and enter here. This is the

total number of DSEs for total number of DSEs for

this subscriber group this subscriber group

subject to the surcharge subject to the surcharge

computation . . . . . . . . . . . . . . - computation . . . . . . . . . . . . . . -

SYNDICATED EXCLUSIVITY SYNDICATED EXCLUSIVITYSURCHARGE SURCHARGE

First Group . . . . . . . . . . . . . . . $ Second Group . . . . . . . . . . . . . . $

Line 1: Enter the VHF DSEs . . . . Line 1: Enter the VHF DSEs . . . .

Line 2: Enter the Exempt DSEs. . Line 2: Enter the Exempt DSEs. .

Line 3: Subtract line 2 from line 1 Line 3: Subtract line 2 from line 1 and enter here. This is the and enter here. This is the total number of DSEs for total number of DSEs for this subscriber group this subscriber group subject to the surcharge subject to the surcharge

computation . . . . . . . . . . . . . . - computation . . . . . . . . . . . . . . -

SYNDICATED EXCLUSIVITY SYNDICATED EXCLUSIVITYSURCHARGE SURCHARGE

Third Group . . . . . . . . . . . . . . . . . $ Fourth Group . . . . . . . . . . . . . . . $

SYNDICATED EXCLUSIVITY SURCHARGE: Add the surcharge for each subscriber group as shownin the boxes above. Enter here and in block 4, line 2 of space L (page 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

THIRD SUBSCRIBER GROUP FOURTH SUBSCRIBER GROUP

Name

BLOCK B: COMPUTATION OF SYNDICATED EXCLUSIVITY SURCHARGE FOR EACH SUBSCRIBER GROUP

9

FIRST SUBSCRIBER GROUP SECOND SUBSCRIBER GROUP

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 33: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

ACCOUNTING PERIOD:  2018/1

FORM SA3E. PAGE 20.LEGAL NAME OF OWNER OF CABLE SYSTEM: SYSTEM ID#Southwestern Bell Telephone Company 62828

If your cable system is located within a top 100 television market and the station is not exempt in Part 7, you must also compute a

Syndicated Exclusivity Surcharge. Indicate which major television market any portion of your cable system is located in as definedby section 76.5 of FCC rules in effect on June 24, 1981:

Computationof First 50 major television market Second 50 major television market

Base Rate Fee INSTRUCTIONS:and Step 1: In line 1, give the total DSEs by subscriber group for commercial VHF Grade B contour stations listed in block A, part 9 of

Syndicated this schedule.Exclusivity Step 2:  In line 2, give the total number of DSEs by subscriber group for the VHF Grade B contour stations that were classified as

Surcharge Exempt DSEs in block C, part 7 of this schedule. If none enter zero.for Step 3:  In line 3, subtract line 2 from line 1. This is the total number of DSEs used to compute the surcharge.

Partially Step 4:  Compute the surcharge for each subscriber group using the formula outlined in block D, section 3 or 4 of part 7 of this

Distant schedule. In making this computation, use gross receipts figures applicable to the particular group. You do not need to showStations your actual calculations on this form.

Line 1: Enter the VHF DSEs . . . . . . . Line 1: Enter the VHF DSEs . . . . . .

Line 2: Enter the Exempt DSEs . . . . . Line 2: Enter the Exempt DSEs . . . . .

Line 3: Subtract line 2 from line 1 Line 3: Subtract line 2 from line 1 and enter here. This is the and enter here. This is the

total number of DSEs for total number of DSEs for

this subscriber group this subscriber group

subject to the surcharge subject to the surcharge

computation . . . . . . . . . . . . . . - computation . . . . . . . . . . . . . . -

SYNDICATED EXCLUSIVITY SYNDICATED EXCLUSIVITYSURCHARGE SURCHARGE

First Group . . . . . . . . . . . . . . . $ Second Group . . . . . . . . . . . . . . $

Line 1: Enter the VHF DSEs . . . . Line 1: Enter the VHF DSEs . . . .

Line 2: Enter the Exempt DSEs. . Line 2: Enter the Exempt DSEs. .

Line 3: Subtract line 2 from line 1 Line 3: Subtract line 2 from line 1 and enter here. This is the and enter here. This is the total number of DSEs for total number of DSEs for this subscriber group this subscriber group subject to the surcharge subject to the surcharge

computation . . . . . . . . . . . . . . - computation . . . . . . . . . . . . . . -

SYNDICATED EXCLUSIVITY SYNDICATED EXCLUSIVITYSURCHARGE SURCHARGE

Third Group . . . . . . . . . . . . . . . . . $ Fourth Group . . . . . . . . . . . . . . . $

SYNDICATED EXCLUSIVITY SURCHARGE: Add the surcharge for each subscriber group as shownin the boxes above. Enter here and in block 4, line 2 of space L (page 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

SEVENTH SUBSCRIBER GROUP EIGHTH SUBSCRIBER GROUP

Name

BLOCK B: COMPUTATION OF SYNDICATED EXCLUSIVITY SURCHARGE FOR EACH SUBSCRIBER GROUP

9

FIFTH SUBSCRIBER GROUP SIXTH SUBSCRIBER GROUP

U.S. Copyright Office Form SA3E Long Form (Rev. 05‐17)

Page 34: STATEMENT OF ACCOUNT FOR COPYRIGHT OFFICE USE …San Antonio, TX 78215-2109 coplicsoa@loc.gov STATEMENT OF ACCOUNT ALLOCATION NUMBER B 6282820181 Return completed workbook by email

CONTROL #:          REMITTANCE #:

Cable ID # Initials

Reviewed by Allocation number

Date of remittance     

Amount

Examined byDate examination 

completed

Cable

      Worksheet

     

Total amount of 

remittance              

Number of SAs rec'd Initials

 

Space A

Accounting

Period

Space D

Area Served

Space B

Owner

Space G

Primary

Transmitters:

Television

Space E

Secondary

Transission

Service

Subscribers:

and Rates

Space H

Primary

Transmitters:

Radio

Space I

Substitute

Check EFT FILING FEES

January 1 - June 30, 2017 July 1 - December 31, 2017

Letter sent

Accepted

Information received

Phone call/Date/ContactAccepted

Letter sent

Accepted

Information received

Phone call/Date/Contact

Letter sent

Accepted

Letter sent

AcceptedAccepted

Letter sent

AcceptedAcceptedAccepted

Information received

Phone call/Date/Contact

Information received

Phone call/Date/Contact

Information received

Phone call/Date/Contact

Phone call/Date/ContactAccepted

67 of 68

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Space J

Part‐time

Carriage Log

(SA3 only)

Substitute

Carriage

Space L

Copyright Filing 

and Royalty Fees

Space K

Gross Receipts

Space O

Certification

Space M

Channels

Space Q

Interest

Assessment

Space P

Statement of 

Gross Receipts

Letter sent Information received

Accepted

Letter sent

Accepted

Letter sent

Letter sent

Royalty Fee should be

Letter sent

Accepted

Letter sent

Accepted

Letter sent

Accepted

Letter sent

Accepted

Phone call/Date/Contact

Information received

Phone call/Date/Contact

Information received

Phone call/Date/Contact

Refund request to fiscal

Information received

Phoe call/Date/Contact

Information received

Phone call/Date/Contact

Information received

Phone call/Date/Contact

Information received

Phone call/Date/Contact

Letter sent

Accepted

Info/add'l fee received

Phone call/Date/Contact

68 of 68